Agreement of Antipsychotic Use between Nursing Home Electronic Records and Minimum Data Set

OBJECTIVES

Nursing home (NH) Minimum Data Set (MDS) have frequently been used to measure medication use in epidemiologic studies, but there is little evidence on the accuracy of MDS-based medication records. We compared antipsychotic use estimated using 2 data sources-MDS and NH electronic medication administration records (eMAR).

DESIGN

Cross-sectional comparison.

SETTING AND PARTICIPANTS

This analysis was based on MDS and linked eMAR data of 604 NH residents with dementia at 54 NHs in 10 states, participating in a cluster-randomized pragmatic trial (METRIcAL), from June 2019 to February 2020.

METHODS

One admission, quarterly, or annual MDS assessment was chosen for each participant. The MDS assessment recorded the number of antipsychotic treatment days during a 7-day window. We then identified antipsychotic administrations during the corresponding window in the eMAR. We used Cohen kappa to assess agreement in the proportion of participants on antipsychotics during the week and used intraclass correlation coefficient (ICC) to assess the agreement of treatment days. We further used the eMAR data as a reference to calculate validity parameters.

RESULTS

A total of 29.5% of study participants were identified as antipsychotic users based on the MDS vs 28.3% based on the eMAR data (kappa value: 0.96). MDS-based average treatment duration was estimated to be 2.0, consistent with eMAR-based estimate (1.8 days, ICC: 0.96). The sensitivity was 98.8% (95% CI 95.8%-99.9%), the specificity was 97.9% (95% CI 96.1%-99.1%), the positive predictive value was 94.9% (95% CI 90.8%-97.3%), and the negative predictive value was 99.5% (95% CI 98.2%-99.9%).

CONCLUSIONS AND IMPLICATIONS

Agreement between the MDS and eMAR in antipsychotic use is high, suggesting that the MDS is a valid tool to measure antipsychotic use in epidemiologic studies. Further studies with large and diverse populations are warranted to confirm our findings.

Ambulatory Care Coordination Data Gathering and Use

Care coordination is a crucial component of healthcare systems. However, little is known about data needs and uses in ambulatory care coordination practice. Therefore, the purpose of this study was to identify information gathered and used to support care coordination in ambulatory settings. Survey respondents (33) provided their demographics and practice patterns, including use of electronic health records, as well as data gathered and used. Most of the respondents were nurses, and they described varying practice settings and patterns. Although most described at least partial use of electronic health records, two respondents described paper documentation systems. More than 25% of respondents gathered and used most of the 72 data elements, with collection and use often occurring in multiple locations and contexts. This early study demonstrates significant heterogeneity in ambulatory care coordination data usage. Additional research is necessary to identify common data elements to support knowledge development in the context of a learning health system.

From designing minimum data set to developing kidney transplantation registry in Iran

Objective

Currently, population growth and increasing life expectancy are becoming one of the biggest public health challenges in the world, which has increased the prevalence of chronic diseases such as end-stage renal disease and the need for kidney transplantation. The use of a variety of registries has the potential to determine the effectiveness of clinical care and costs and improve the quality of patient care. The aim of this study is to design minimum data set to develop a kidney transplantation registry in Iran to improve the quality of care for people with end-stage renal disease.

Methods

The present research is descriptive-applied. The minimum data set was reviewed and evaluated in expert panel meetings. The various elements of the minimum data set were discussed, and specialists in urology, nephrology, health information management, and medical informatics presented their views.

Results

The characteristics of the kidney transplantation registry in the form of eight axes of purpose, structure, data sources, minimum data set, classification systems, data processing and reporting, distribution and access to information, and data quality were extracted and finally these characteristics were approved by experts. The relevant tables were validated and were within the acceptable range from the point of view of experts.

Conclusion

In developing a kidney transplantation registry in Iran, the necessary requirements and features for designing a web-based registry have been considered. The prototype of this registry in the country will help to collect higher quality data. It is hoped that by developing this registry, a step will be taken to better manage the information on people with end-stage renal disease, provide better services to these patients, and facilitate related research.

Designing a minimum data set for the information management system (registry) of spinal canal stenosis: An applied-descriptive study

Background and Aims

Spinal canal stenosis is one of the most common vertebral column diseases, which can lead to disability. Developing a registry system can help in research on the prevention and effective treatment of it. This study designs a minimum data set (MDS) as the first step in creating a registry system for spinal canal stenosis.

Method

The present research is of applied-descriptive type, performed in 2022. First, the applicable data elements about the disease were selected from a vast range of English and Farsi references, including peer reviewed articles, academic books, credible websites, and medical records of hospitalized patients. Through the extracted data, the primary MDS plan was designed as a questionnaire. The validity of the questionnaire was conducted via asking the opinion of experts (neurosurgeons, physiotherapists, epidemiologists, and health information management specialists). Also, its reliability was calculated via Cronbach ⍺ coefficient, which was 86%. Finally, the MDS of the spinal canal stenosis national registry system (for Iran) was confirmed through a two stage Delphi technique. Data analysis was applied through descriptive statistics via SPSS21 software.

Results

The proposed MDS is offered in two general sets of data: administrative and clinical. For the administrative data set, 40 data elements had been proposed, as five classes. Twenty-six of them were confirmed. In the clinical section, 95 data elements had been proposed in 14 classes; 94 of which were finally confirmed.

Conclusion

Since there is no spinal canal stenosis MDS available, this study can be a turning point in the standardization of the data on this disease. Moreover, these precise, coherent, and standard data elements can be contributed to improving disease management and enhancing the public healthcare quality. Also, the MDS proposed in this study can help researchers and experts, design a spinal canal stenosis registry system in other countries.

Soil quality and ecological benefits assessment of alpine desertified grassland following different ecological restoration measures

Introduction

Soil quality plays an irreplaceable role in plant growth for restored grassland. However, few studies investigate the comprehensive effects considering soil and vegetation properties during the restoration of desertified grassland, which restrict the virtuous circle of restored grassland ecosystem.

Methods

By setting three restoration patterns of enclosure plus grass (EG), enclosure intercropping shrub-grass (ESG), and enclosure plus sand-barrier and shrub-grass (ESSG) with three different restoration years (≤5, 7-9, and ≥15 years), we selected 28 physicochemical and microbial indicators, and constructed a minimum data set (MDS) to analyze the influences of restoration measurements on soil quality and ecological benefits in alpine desertified grassland.

Results

The results showed that the MDS comprised seven soil quality indicators: silt, total nitrogen (TN), carbon-nitrogen ratio (C/N), total potassium (TK), microbial biomass carbon (MBC), microbial biomass phosphorus (MBP), and fungi. Soil quality index (SQI) and ecological restoration effect index (EREI) in restored grasslands significantly increased by 144.83-561.24% and 87.21-422.12%, respectively, compared with unrestored grassland, and their positive effects increased with extending restoration years. The increasing effects of SQI and EREI were the highest in ESSG, followed by EG and ESG. The increasing rate of SQI began to decrease after 5 years in EG and ESG, while it decreased after 7-9 years in ESSG, and that of EREI in EG was lower than ESSG in each restoration year. Our work revealed that ESSG was the optimum restoration pattern for desertified grassland, and anthropogenic monitoring and management measurements such as applying organic fertilization and mowing return reasonably should be carried out at the beginning of 5 years in EG and ESG as well as 7 years in ESSG to maintain sustainable ecological benefits.

Discussion

The study highlights that soil quality, including microbial properties, is a key factor to evaluate the restoration effects of desertified grassland.

The Minimum Data Set for Rare Diseases: Systematic Review

BACKGROUND

The minimum data set (MDS) is a collection of data elements to be grouped using a standard approach to allow the use of data for clinical and research purposes. Health data are typically voluminous, complex, and sometimes too ambiguous to generate indicators that can provide knowledge and information on health. This complexity extends further to the rare disease (RD) domain. MDSs are essential for health surveillance as they help provide services and generate recommended population indicators. There is a bottleneck in international literature that reveals a global problem with data collection, recording, and structuring in RD.

OBJECTIVE

This study aimed to identify and analyze the MDSs used for RD in health care networks worldwide and compare them with World Health Organization (WHO) guidelines.

METHODS

The population, concept, and context methodology proposed by the Joanna Briggs Institute was used to define the research question of this systematic review. A total of 4 databases were reviewed, and all the processes were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. The data elements were analyzed, extracted, and organized into 10 categories according to WHO digital health guidelines. The quality assessment used the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist.

RESULTS

We included 20 studies in our review, 70% (n=14) of which focused on a specific health domain and 30% (n=6) of which referred to RD in general. WHO recommends that health systems and networks use standard terminology to exchange data, information, knowledge, and intelligence in health. However, there was a lack of terminological standardization of the concepts in MDSs. Moreover, the selected studies did not follow the same standard structure for classifying the data from their MDSs. All studies presented MDSs with limitations or restrictions because they covered only a specific RD, or their scope of application was restricted to a specific context or geographic region. Data science methods and clinical experience were used to design, structure, and recommend a fundamental global MDS for RD patient records in health care networks.

CONCLUSIONS

Our study highlights the difficulties in standardizing and categorizing findings from MDSs for RD because of the varying structures used in different studies. The fundamental RD MDS designed in this study comprehensively covers the data needs in the clinical and management sectors. These results can help public policy makers support other aspects of their policies. We highlight the potential of our results to help strategic decisions related to RD.

TRIAL REGISTRATION

PROSPERO CRD42021221593; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=221593.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1016/j.procs.2021.12.034.

Designing a minimum data set of laboratory data for the electronic summary sheet of pediatric ward in Iran: A cross-sectional study

Background and Aim

Iranian hospitals are provided with hospital information systems (HISs) from different vendors, which make it hardly possible to summarize laboratory data in an consistent manner. Therefore, there is a need to design a minimum data set of laboratory data that will define standard criteria and reduce potential medical errors. The purpose of this study was to design a minimum data set (MDS) of laboratory data for an electronic summary sheet to be used in the pediatric ward of Iranian hospitals.

Methods

This study consists of three phases. In the first phase, out of 3997 medical records from the pediatric ward, 604 summary sheets were chosen as sample. The laboratory data of these sheets were examined and the recorded tests were categorized. In the second phase, based on the types of diagnosis we developed a list of tests. Then we asked the physicians of the ward to select which ones should be documented for each patient's diagnosis. In the third phase, the tests that were reported in 21%-80% of the records, and were verified by the same percentage of physicians, were evaluated by the experts' panel.

Results

In the first phase, 10,224 laboratory data were extracted. Of these, 144 data elements reported in more than 80% of the records, and more than 80% of experts approved them to be included in the MDS for patients' summary sheet. After data elements were investigated in the experts' panel, 292 items were chosen for the final list of the data set.

Conclusions

This MDS was designed such that, if implemented in hospital information systems, it could automatically enable registering data in the summary sheet when patient's diagnosis is registered.

Soil quality evaluation of different land use patterns on the southern and northern Qinghai-Tibet Plateau based on minimal data set

To evaluate soil quality status of forest, grassland, and cropland in the southern and northern Tibetan Plateau, and to clarify the key influencing factors of productivity levels under three land use types, we measured the basic physical and chemical properties of 101 soil samples collected in the northern and southern Qinghai-Tibet Plateau. Principal component analysis (PCA) was used to select three indicators as the minimum data set (MDS) to comprehensively evaluate soil quality of the southern and northern Qinghai-Tibet Plateau. The result showed that soil physical and chemical properties of the three land use types were significantly different in the north and south. The contents of soil organic matter (SOM), total nitrogen (TN), available phosphorus (AP) and available potassium (AK) in the north were higher than those in the south, while the contents of SOM and TN of forest were signi-ficantly higher than those of cropland and grassland in both the north and south. Soil ammonium (NH₄⁺-N) content showed a pattern of cropland > forest > grassland, with significant difference in the south. Soil nitrate (NO₃^--N) content in the north and south was the highest in the forest. Soil bulk density (BD) and electrical conductivity (EC) of cropland were significantly higher than those of grassland and forest, and that of cropland and grassland in the northern part was higher than that of southern part. Soil pH of grassland in the south was significantly higher than that of forest and cropland, and that of forest was the highest in northern part. The selected indicators for eva-luating soil quality in the north were SOM, AP, and pH, and soil quality index of forest, grassland, and cropland was 0.56, 0.53 and 0.47. The selected indicators were SOM, total phosphorus (TP), and NH₄⁺-N in the south, and soil quality index of grassland, forest and cropland was 0.52, 0.51 and 0.48, respectively. There was a significant correlation between soil quality index obtained by the total data set and the minimum data set, and the regression coefficient was 0.69. Soil quality in the north and south of the Qinghai-Tibet Plateau were grade Ⅲ, and soil organic matter was the main indicator limiting soil quality in this area. Our results provide a scientific basis for eva-luating soil quality and ecological restoration in the Qinghai-Tibet Plateau.

[Effects of combined application of biochar and nitrogen fertilizer on soil quality of summer maize-winter wheat system]

The effects of nitrogen fertilizer and biochar on topsoil quality in the drylands of northwest China were studied in field trials for two years. A split plot design with two factors was adopted, with five nitrogen rates (0, 75, 150, 225 and 300 kg N·hm^-2) as main plots, and two rates of biochar (0 and 7.5 t·hm^-2) as submain plots. We collected soil samples at 0-15 cm depth after two years of winter wheat-summer maize rotation and measured physical, chemical, and biological properties. The minimum data set (MDS) was established by using principal component analysis and correlation analysis to analyze the responses of soil quality to nitrogen fertilizer and biochar addition. The results showed that the combined application of nitrogen fertilizer and biochar could improve soil physical properties, increase macroaggregate content, reduce soil bulk density, and increase soil porosity. Both fertilizer application and biochar application had a significant effect on soil microbial biomass carbon and nitrogen. The application of biochar could improve soil urease activity and the contents of soil nutrients and organic carbon. Six out of 16 indicators (urease, microbial biomass carbon, total phosphorous, total nitrogen, pH, and available potassium) relating to soil quality were used to construct MDS, and soil quality index (SQI) was calculated. The variation range of SQI was 0.14-0.87, with that of 225 and 300 kg N·hm^-2 nitrogen application combined with biochar application being significantly higher than other treatments. Soil quality could be significantly improved by application of nitrogen fertilizer and biochar. Interactive effect was observed, which was particularly stronger under high nitrogen application rate.

[Hemodialysis safety: from the study of the minimum data set to the creation of the CUSTODE hemodialysis surveillance flow sheet]

Background: The purpose of the study is to identify, through a survey, the parameters that need to be monitored during a hemodialysis session and to merge them into a surveillance flow sheet that allows the optimal conduction of the treatment. Methods: The study was conducted using the questionnaire methodology and involved 78 nurses working in the nephrological area in Italy. The majority of participants have an age of service greater than 10 years and belong to a hemodialysis context. Results: The data show how the surveillance flow sheet is a diversified tool according to the treatments carried out. However, the majority of dialysis flow sheets have a section dedicated to the medical-nursing diary, a space for recording the access characteristics and there is also a good level of digitalization of the instrument. The frequency of detection of vital and monitor-related parameters varies on the basis of the treatment carried out, the registration of the identification number and the filter label are not a uniform practice. Finally, the majority points out the need for an improvement of the surveillance card in use. Conclusions: The research highlights the lack of uniformity of the dialysis surveillance process. The study proposes as a solution to the problem a universal medical-nursing flow sheet, called CUSTODE, which can guide the professional in the management of hemodialytic treatment, through the registration of a minimum data set.

[Comprehensive evaluation of soil quality of different land use types on the northeastern margin of the Qinghai-Tibet Plateau, China]

Soil quality evaluation is an important prerequisite for the rational soil resource utilization. We collected soil samples from forest (n=9), grassland (n=18) and cropland (n=38) in Tianzhu County, Gansu Province, which is located on the northeastern edge of the Qinghai-Tibet Plateau. Soil quality was evaluated based on thirteen soil physical and chemical indicators, including soil bulk density, field capacity, and organic matter. A minimum data set (MDS) was constructed using principal component analysis and correlation analysis to establish a soil qua-lity evaluation index (SQI) system, which was used in the soil quality evaluation for the three land-use types. The results showed that total porosity, capillary porosity, field capacity, capillary water capacity, saturated water content, organic matter, total nitrogen and available potassium content were significantly higher in forest than those in grassland and cropland. The SQI system of forest was based on field capacity, organic matter, total nitrogen, available nitrogen, and available potassium, and the SQI ranged between 0.329 to 0.678, with a mean value of 0.481. Grassland SQI system was based on field capacity and available nitrogen, with the SQI ranging between 0.302 to 0.703 and a mean value of 0.469. Cropland SQI system was based on capillary water capacity, non-capillary porosity, available nitrogen, available phosphorus, and available potassium, and the SQI ranged from 0.337 to 0.616 with a mean value of 0.462. The most important barriers to soil quality improvement in forest, grassland, and cropland were available potassium, field capacity, and capillary water capacity, respectively. The MDS-based SQI enabled an accurate evaluation of soil quality across different land-use types in the study area, which was best in forest followed by grassland and cropland. The evaluation results would provide important reference for sustainable soil management in the local area.

Establishing a minimum data set for Parkinson's (PMDS) in Iran

BACKGROUND

The minimum data set (MDS) is one of the important steps in the development of health care information systems. According to the Ministry of Health in Iran, a central and national registry along with Parkinson's MDS (PMDS) has not yet existed. So, this research was conducted to establish a PMDS in Iran.

MATERIAL AND METHODS

This study was a descriptive-comparative method, which was done in 2019-2021 in four phases: (1) determining data elements related to Parkinson's disease in Iran and selected countries; (2) extracting and categorizing the data elements; (3) making a PMDS draft; (4) evaluating a draft by Delphi technique. The research population was the MDS in Australia, Canada, the United States of America, and Iran. After extracting the data elements of Parkinson's disease from various resources, the primary draft PMDS was developed. Then, the research group divided it into two categories (administrative and clinical). After that, it was sent to 50 healthcare professionals for validation by the Delphi method.

RESULTS

Following the results of the two rounds of Delphi technique, Finally, PMDS was established including a total of 223 data elements in two categories: administrative and clinical with 72 and 151, respectively. Every category included 10 and 14 subcategories.

CONCLUSION

The first and the most important step for standardization of data collection nationally is creating MDS. Due to the necessity of the existence of PMDS, a complete list of PMDS was established for collecting data on Parkinson's patients.

Soil Quality Assessment in Tourism-Disturbed Subtropical Mountain Meadow Areas of Wugong Mountain, Central Southeast China

Meadow soil is a vital ecosystem component and can be influenced by meadow vegetation. Evaluating soil quality in mountain meadows subjected to different levels of tourism disturbance is essential for scientific research, ecological restoration, and sustainable management. This study aimed to evaluate meadow soil quality at different tourism-disturbance levels and attempted to establish a minimum data set (MDS) with compatible indicators for soil quality assessment of subtropical mountain meadows. We analyzed fifteen soil physical, chemical, and biological indicators in control check (CK), light disturbance (LD), medium disturbance (MD), and severe disturbance (SD) meadow areas in Wugong Mountain, west of Jiangxi, China. In addition, a soil quality index (SQI) was determined using the established MDS based on the integrated soil quality index. Average soil permeability, soil pH, available nitrogen (AN), available phosphorus (AP), and number of fungal OTUs were finally introduced into the MDS to evaluate meadow soil quality at different tourism-disturbance levels. The study found that the soil of the Wugong Mountain meadow was acidic, the bulk density was loose, and the nutrient content was rich. Additionally, SQI decreased with increase in tourism-disturbance level. The mean SQI values of the Wugong Mountain meadow areas were: CK, 0.612; LD, 0.493; MD, 0.448; and SD, 0.416. Our results demonstrate that the SQI based on the MDS method could be a valuable tool with which to indicate the soil quality of mountain meadow areas, and the SQI can be regarded as a primary indicator of ecological restoration and sustainable management.

Designing the minimum data set of bipolar disorder: A basis for introducing the effective factors in managing, controlling, and monitoring the bipolar disorder

BACKGROUND AND AIM

Bipolar disorder (BD) is one of the most challenging psychiatric disorders in the management area that can lead to functional, occupational, and cognitive disorders. Without proper care, this complication can lead to profound psychological challenges and even death. The aim of this study is to design a minimum data set (MDS) for BD.

MATERIALS AND METHODS

This descriptive cross-sectional study was conducted in two steps. In the first step, a survey was conducted in PubMed, Web of Science, and SCOPUS databases to identify the demographic, managerial, and clinical data elements. Then, the required data elements were extracted from the studies by the data extraction form and used in a questionnaire. In the second step, to confirm the data element set, the designed questionnaire was distributed and collected among 20 psychiatrists and subspecialists during a two-stage Delphi technique. Descriptive statistics (frequency and mean) were conducted to analyze the data.

RESULTS

Totally, 112 managerial and clinical data elements in 14 categories were extracted from the studies. Based on the experts' opinion and their consensus, 88 necessary data elements were considered to bipolar MDS. "Medication nonadherence," "history of suicide," and "substance abuse and addiction" were the most important data elements.

CONCLUSION

In this study, an MDS was designed for BD. Providing this MDS, in addition to improving the clinical processes, it is possible to help electronic system designers and health data managers to know what information should be included in the health systems or any kind of self-care or self-management software to meet the information needs of these patients.

Soil chemical quality assessment and spatial distribution of pomelo orchards in acidic red soil hilly regions of China

BACKGROUND

Soil quality assessment is a critical strategy for determining optimum fertilization in intensive pomelo production. In this study, we evaluated the soil quality status and mapped the spatial distribution of 347 soil samples collected from pomelo orchards in Pinghe County, southern China. We analyzed nine chemical parameters and an altitude indicator.

RESULTS

The mean soil quality index (SQI) was 0.355 in the total data set (TDS) and 0.292 in the minimum data set (MDS). Available Ca (Avail-Ca), pH value, organic matter and altitude were selected as indicators of soil quality in the MDS. The SQI in mature orchards (>10 years) was higher than that in young orchards (<10 years), while no differences between soil types and altitude gradients were identified. We detected a significant positive correlation between the SQI based on TDS (SQI_TDS ) and the SQI based on MDS (SQI_MDS ), and the spatial distribution of soil properties and SQI_TDS showed a uniform pattern, except for Avail-N, Avail-B and SQI_MDS . Overall, unfavorable soil quality indicators, including rich in Avail-P, deficient in Avail-Ca, -Mg and -B, soil acidification and high altitude, were considered to be limiting factors for pomelo production.

CONCLUSION

The soil chemical quality in pomelo orchards is generally low, indicating that integrated management by controlling acidification, reducing planting altitude, regulating fertilization and monitoring soil properties is required for sustainable pomelo production. © 2021 Society of Chemical Industry.

[Quality-based soil fertility quality assessment of American ginseng main production areas in Shandong province]

The soil fertility quality is one of the most critical indicators of soil productivity. It directly affects the yield, quality and agricultural efficiency of Chinese medicinal materials. In order to establish the American ginseng planting soil fertility quality evaluation method based on the effective components of American ginseng, Wendeng district, Weihai city, Shandong province, the main producing area of American ginseng, was cited as a case for the study. Twenty-two 4-years American ginseng sampling sites are located at 7 towns. The samples of soil and plant root were collected in the autumn of 2017-2019. The saponin contents of American ginseng and 11 soil chemical properties were measured. The minimum data set(MDS) for assessment of the quality of soil fertility quality was established by correlation analysis and principal component analysis. The evaluation indexes were normalized by membership function. Soil quality index(SQI) that indicates soil comprehensive fertility quality level was calculated according to the critical value of membership function and weight value of each soil index in MDS. The results showed that the total saponin(Rg_1+Re+Rb_1) content of American ginseng in samples ranged from 1.76% to 7.94%. The yield of 8 plots in 2019 ranged from 3 818.7 kg·hm~(-2) to 8 996.4 kg·hm~(-2). MDS includes organic matter, alkaline nitrogen, exchangeable calcium, exchangeable magnesium, effective iron, effective copper, and effective zinc. Based on the mean of 4.825% of total saponin, threshold value of SQI for the region was determined to be 0.15, and 86.36% of soil samples in the county were above the threshold value. The methods and parameters are applicable to selection of high quality American ginseng planting sites and guiding rational fertilization. It also provides a reference for the evaluation of soil fertility quality of other medicinal plants.

Development and validation of the Neonatal Abstinence Syndrome Minimum Data Set (NAS-MDS): a systematic review, focus group discussion, and Delphi technique

OBJECTIVES

Neonatal abstinence syndrome (NAS) is a combination of symptoms in infants exposed to any variety of substances in utero. Information systems and registries help to collect information about these patients; however, there is always a deep gap between complete and accurate information to be collected, understood, and applied in the health care system; thus, defining a minimum data sets (MDS) as one of the primarily steps of designing a registry system is essential. The aim of this study was to develop an MDS of the registry for infants with NAS in Iran.

METHODS

This research is a descriptive cross-sectional study. In this study, three steps were carried out to develop the MDS including systematic review, Delphi technique, and focus group discussion. A systematic review was conducted in relevant databases to identify appropriate related data. In the second phase, a focus group discussion was used to classify the extracted data elements by contributing neonatologists. Finally, data elements were chosen through the decision Delphi technique in two distinct rounds. Collected data were analyzed using SPSS 22 (SPSS Inc., Chicago, IL).

RESULTS

By reviewing related papers and available NAS registries in other countries, 145 essential data elements were identified. They were classified into two main categories based on the eight experts' opinions including maternal with two sections and infant with two sections. After applying two rounds of Delphi technique, the final data elements for maternal and infant categories were 42 and 31, respectively. Thus, on completion of the survey, 73 data elements were approved.

CONCLUSION

The proposed MDS for NAS can help to store an accurate and comprehensive data, document medical records, integrate them with other information systems and registries, and communicate with other healthcare providers and healthcare centers. This MDS can contribute to the provision of high-quality care and better clinical decisions.

A minimum data set of user profile or electronic health record for chemical warfare victims' recommender system

Background:

There are many people who are suffering from a variety of physical and mental illnesses due to the chemical attacks. There are various technologies such as recommender systems that can identify the main concerns related to health and make efforts to address them. To design and develop a recommender system, preparation of data source of this system should be considered. The aim of this study was to determine the minimum data set for user profile or user's electronic health record in chemical warfare victims’ recommender system.

Methods:

This applied descriptive, cross-sectional study which was conducted in 2017. A questionnaire was developed by the authors from the data elements that were collected using the data extraction form from the studied sources. Content validity of the questionnaire was confirmed by using the experts. Test–retest method was used to determine the reliability of the questionnaire. The reliability of the questionnaire with Cronbach's alpha coefficient was confirmed as 84%. The questionnaire were submitted for related experts based on Delphi method by email or in person. Data resulting from the Delphi technique with descriptive statistics methods in SPSS software were analyzed.

Results:

Forty-seven nonclinical data elements and 181 clinical data elements were classified.

Conclusion:

Determining minimum data set of user profile or electronic health record in the recommender system for chemical warfare victims helps the health authorities to implement the recommender system which demonstrates chemical warfare victims’ needs.

Development of a core data set for pelvic floor disorder patients registry

OBJECTIVES

Pelvic floor disorders (PFDs) are important public health concerns due to their increasing prevalence. Hence, there is an increasing need for developing systematically collected quality data to assist appropriate clinical decision-making. This study aimed to develop a core data set for patients with PFDs based on the PFDs registry.

METHODS

A descriptive cross-sectional study was conducted in 2019. Data were retrieved from electronic databases including PubMed, Embase and Google scholar. Available documents and data systems in clinical centers were also assessed. The Delphi technique was applied to reach a consensus about the data elements using a questionnaire. A panel of experts evaluated the content validity of the questionnaire.

RESULTS

We developed a dataset for PFDs that included two classes of data (65 data items) identified from the related literature. In the Delphi survey, 74 data elements were determined by the experts and final data were divided into two demographic and clinical categories that included 12 and 62 data elements, respectively.

CONCLUSIONS

This dataset has the potential for standardizing the data by providing accurate, consistent, complete and uniform data elements. Furthermore, it can provide valuable research facilities for clinicians and researchers in the healthcare system resulting in improvement of the quality of care and containment of costs.

Improving hypertension surveillance from a data management prospective: Data requirements for implementation of population-based registry

BACKGROUND

Hypertension (HTN) has become a major public health problem which can cause serious complications when it is not well-controlled. Prevention and effective care of HTN require a population-based registry. Thus, establishing this registry can be used to collect comprehensive, timely, and reliable data on epidemiology cases. The aim is to create a registry for the collection of highly required prospective data that will present an in-depth analysis of the characteristics of all individuals with HTN and track them over a particular chronological interval.

MATERIALS AND METHODS

The study was divided into three phases: At first, a comprehensive literature review was conducted to determine the proposed data classes and data fields. Then, the final minimum data set was designed by a two-round Delphi consensus approach of 20 experts of cardiologists, nephrologists, nutritionist, and health information management. Finally, a web-based registry system was developed by a Structured Query Language environment.

RESULTS

A total of two clinical and nonclinical data categories with nine data classes and 68 data fields were selected for their inclusion in the registry following the consensus phase. A web-based registry was designed with a modular and layered architecture.

CONCLUSIONS

This study provides an appropriate information infrastructure for active tracing and monitoring of individuals with HTN. It has provided a practical information system allowing quality improvement, aggregate reporting for planning, and research purposes.

Establishment of an internationally agreed minimum data set for acute telestroke

INTRODUCTION

Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes.

METHODS

An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers (n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email.

RESULTS

Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme (n = 12), (2) details about initiating hospital (n = 10), (3) telestroke consultation (n = 17), (4) patient characteristics (n = 7), (5) presentation to hospital (n = 5), (6) general clinical care within first 24 hours (n = 10), (7) thrombolysis treatment (n = 10), (8) endovascular treatment (n = 13), (9) neurosurgery treatment (n = 8), (10) processes of care beyond 24 hours (n = 7), (11) discharge information (n = 5), (12) post-discharge and follow-up data (n = 6).

DISCUSSION

The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.

Coronavirus disease 2019 (COVID-19) surveillance system: Development of COVID-19 minimum data set and interoperable reporting framework

INTRODUCTION

The 2019 coronavirus disease (COVID-19) is a major global health concern. Joint efforts for effective surveillance of COVID-19 require immediate transmission of reliable data. In this regard, a standardized and interoperable reporting framework is essential in a consistent and timely manner. Thus, this research aimed at to determine data requirements towards interoperability.

MATERIALS AND METHODS

In this cross-sectional and descriptive study, a combination of literature study and expert consensus approach was used to design COVID-19 Minimum Data Set (MDS). A MDS checklist was extracted and validated. The definitive data elements of the MDS were determined by applying the Delphi technique. Then, the existing messaging and data standard templates (Health Level Seven-Clinical Document Architecture [HL7-CDA] and SNOMED-CT) were used to design the surveillance interoperable framework.

RESULTS

The proposed MDS was divided into administrative and clinical sections with three and eight data classes and 29 and 40 data fields, respectively. Then, for each data field, structured data values along with SNOMED-CT codes were defined and structured according HL7-CDA standard.

DISCUSSION AND CONCLUSION

The absence of effective and integrated system for COVID-19 surveillance can delay critical public health measures, leading to increased disease prevalence and mortality. The heterogeneity of reporting templates and lack of uniform data sets hamper the optimal information exchange among multiple systems. Thus, developing a unified and interoperable reporting framework is more effective to prompt reaction to the COVID-19 outbreak.

[Assessment of Soil Quality in Coastal Tidal Flat Reclamation Areas Based on MDS-TOPSIS Model]

Investigating the change of soil quality during reclamation can provide scientific guidance for desalinization, fertilization, etc. Soil samples were collected from natural tidal flat areas (0 years) and coastal tidal flat reclamation areas with different reclamation years (5, 30, 38, and 61 years) to assess the changes in soil quality after 60 years of reclamation. Soil quality was evaluated using a soil quality index (SQI), which was calculated by the selected minimum data set (MDS) and TOPSIS method. The ratio of clay content (CLAY), soil salt content (SSC), soil organic carbon (SOC), total potassium (TK), and bulk density (BD) were selected as soil quality indicators involving soil physical and chemical properties based on the MDS. The results showed that soil particle size tended to refine gradually with the continuous decrease of sand content and increase of silt and clay content. Simultaneously, soil water content (SWC) and soil BD decreased gradually during the reclamation period. Additionally, SSC, pH and sodium adsorption ratio (SAR) decreased significantly with increase in reclamation years, whereas the nutrients and available nutrients were accumulated gradually, such as soil organic matter (SOM), total nitrogen (TN), total phosphorus (TP), available nitrogen (AN), and available phosphorus (AP). However, C/N, TK and available potassium (AK) showed a decrease with increasing reclamation years, and the cation exchange capacity (CEC) showed a trend of first decrease and then increase. Finally, SQI values varied from 24.06 in the bare flat soils to 63.08 in the soils after 63 years of reclamation, and showed that bare flat (20.04±11.48) < reclamation for 5 years (29.33±10.65) < reclamation for 30 years (51.52±8.76) ≈ reclamation for 38 years (49.98±10.75) < reclamation for 61 years (58.37±3.15), which has gone through approximately three stages of "initial stability-rapid improvement-relative stability." Soil CLAY content had the highest obstacle degree towards SQI among the selected MDS indicators, followed by SSC, SOM, TK, and SWC, and thereby the lower clay content and higher salt content were the main obstacle factors for promotion of soil quality in reclamation areas.

A Systematic Review Evaluating the Use of the interRAI Home Care Instrument in Research for Older People

Objective: To summarize studies that used the international Resident Assessment home care instrument (interRAI HC) to examine study outcomes for older people. Methods: A comprehensive systematic search was performed to identify relevant studies, using five databases from 1990 until October 2016. The Cochrane Risk-Bias assessment tool and Newcastle-Ottawa Scale was used to assess the quality of RCTs and non-RCTs, respectively. Results: Based on the full-text analysis, 40 studies met the inclusion criteria out of 506 total records. The review included 6 RCTs, 2 quasi-experimental, 17 prospective and retrospective studies, 13 cross-sectional and 2 longitudinal studies. A series of interventions and/or applications were identified from this review that employed the use of interRAI HC instrument: (a) in health services, (b) as a new integrated care model and for implementing machine learning algorithm, (c) as a comprehensive geriatric assessment tool, (d) in case management, (e) for care planning and screening, (f) in drug therapy assessment, (g) to assess caregiver burden, and (h) for various risk assessments. Studies that employed the interRAI HC instrument reported an array of health-outcome measures mostly related to functional, cognition, hospitalization and mortality. Conclusions: Application of the interRAI HC tool varied markedly across all studies, and the outcomes measures were heterogeneous. Future research directions are discussed. Clinical Implications: The results from this study facilitate the use of interRAI HC as a tool to measure an intervention's effect that leads to improvements in specific geriatric-related health outcome measures emphasizes on functional status and quality of life and ascertain its utility as a quality indicator for the care of older individuals.

Designing a communication protocol for acquired immunodeficiency syndrome information exchange

INTRODUCTION

Interoperability will provide similar understanding on the meaning of communicated messages to intelligent systems and their users. This feature is essential for controlling and managing contagious diseases which threaten public health, such as acquired immunodeficiency syndrome (AIDS). The aim of this study was also designing communication protocols for normalizing the content and structure of intelligent messages in order to optimize the interoperability.

MATERIALS AND METHODS

This study used a checklist to extract information content compatible with minimum data set (MDS) of AIDS. After coding information content through selected classification and nomenclature systems, the reliability and validity of codes were evaluated by external agreement method. The MindMaple software was used for mapping the information content to Systematized Nomenclature of Medicine-Clinical Terminology (SNOMED-CT) integrated codes. Finally, the Clinical Document Architecture (CDA) format was used for standard structuring of information content.

RESULTS

The information content standard format, compatible selected classification, or nomenclature system and their codes were determined for all information contents. Their corresponding codes in SNOMED-CT were structured in the form of CDA body and title.

CONCLUSION

The complex and multidimensional nature of AIDS requires the participation of multidisciplinary teams from different organizations, complex analyzes, multidimensional and complex information modeling, and maximum interoperability. In this study, the use of CDA structure along with SNOMED-CT codes is completely compatible with optimal interoperability needs for AIDS control and management.

Minimum data set (MDS) based trauma registry, is the data adequate? An evidence-based study from Odisha, India

BACKGROUND

In majority of the low- and middle-income countries (LMICs), the societal cost of injuries are alarming. The severity and magnitude of the road traffic injuries (RTI) in India are not estimated accurately due to the lack of availability of data. The data are limited on the aspects such as demographics, cause, severity of injury, processes of care, and the final outcome of injuries. This study aimed to determine the feasibility of setting up a sustainable trauma registry in Odisha, India, and to determine the demographics, mechanism, severity, and outcomes of injury reported to the facilities/hospital.

MATERIALS AND METHODS

A prospective observational study was conducted at Srirama Chandra Bhanja Medical College and Hospital (SCB-MCH), Cuttack, India. Injured patients who reported/admitted to the emergency department were observed, and data were collected by using a minimum data set (MDS) developed by the World Health Organization (WHO). Data were collected for a period of one month in June 2015. Observations were collected on 20 variables. The completeness of data collection ranged from 60% (19 variables) to 70% (23 variables) out of total 33 variables.

RESULTS

This study uses 145 cases of injury reported in SCB-MCH. Out of the total reported population at the trauma registry, about 21% were females. Nearly 45% of the injury occurred on road/street. RTI accounted for 36.6% of injury. Out of the total admitted cases, 2.8% died in the emergency department, 11% were discharged to home, and 7.6% left against medical advice. Majority of the respondents have reported single injuries (77%). Head injuries were more common and severe among majority of the reported cases (44.1%), followed by neck injury (28.3%) and chest (15.9%).

CONCLUSIONS

This study indicates the challenges in obtaining complete data on injury. Data were missing in terms of admission, discharge, and Glasgow Comma Scale (GCS) among the studied population. This study suggests that individual GCS scoring should be done instead of total GCS scoring in each trauma patient. By collection and storage of adequate data, better policy decisions can be implemented, which will minimize and prevent trauma cases and maximize the utilization of the available resources.

Electronic Medical Records for Mental Disorders: What Data Elements Should These Systems Contain?

Identifying data elements of electronic medical record systems (EMRs) is one of the essential steps for the comprehensive and proper health data collection. The aim of this study was to determine the data elements required for EMRs in the field of mental disorders. We conducted a literature review and also we randomly selected 50 medical records of patients with mental disorders to identify a preliminary list of essential data elements for EMRs for mental disorders. Then, 33 mental health specialists were surveyed to validate the list of data elements through a questionnaire. We identified that health data elements of EMRs for patients with mental disorders can be categorized into seven classes (demographic data of patients, administrative data of physicians, administrative data of patients, history, clinical data, treatment, and financial data) and 10 subclasses. After the validation process, 140 essential data elements for EMRs for patients with mental disorders were introduced.

Development and Validation of a Prognostic Tool for Identifying Residents at Increased Risk of Death in Long-Term Care Facilities

BACKGROUND

To promote better care at the end stage of life in long-term care facilities, a culturally appropriate tool for identifying residents at the end of life is crucial.

OBJECTIVE

This study aimed to develop and validate a prognostic tool, the increased risk of death (IRD) scale, based on the minimum data set (MDS).

DESIGN

A retrospective study using data between 2005 and 2013 from six nursing homes in Hong Kong.

SETTING/SUBJECTS

A total of 2380 individuals were randomly divided into two equal-sized subsamples: Sample 1 was used for the development of the IRD scale and Sample 2 for validation.

MEASUREMENTS

The measures were MDS 2.0 items and mortality data from the discharge tracking forms. The nine items in the IRD scale (decline in cognitive status, decline in activities of daily living, cancer, renal failure, congestive heart failure, emphysema/chronic obstructive pulmonary disease, edema, shortness of breath, and loss of weight), were selected based on bivariate Cox proportional hazards regression.

RESULTS

The IRD scale was a strong predictor of mortality in both Sample 1 (HR_sample1 = 1.50, 95% confidence interval [CI]: 1.37-1.65) and Sample 2 (HR_sample2 = 1.31, 1.19-1.43), after adjusting for covariates. Hazard ratios (HRs) for residents who had an IRD score of 3 or above for Sample 1 and Sample 2 were 3.32 (2.12-5.21) and 2.00 (1.30-3.09), respectively.

CONCLUSIONS

The IRD scale is a promising tool for identifying nursing home residents at increased risk of death. We recommend the tool to be incorporated into the care protocol of long-term care facilities in Hong Kong.

An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses

WHAT IS KNOWN ON THE SUBJECT?: In the United States, 15.5% of nursing home residents without qualifying diagnoses of schizophrenia, Huntington's' Disease, and/or Tourette Syndrome receive antipsychotic medications. Antipsychotic medications are used off-label (i.e., used in a manner the United States Food and Drug Administration's packaging insert does not specify) to treat neuropsychiatric symptoms, often before attempting nonpharmacologic interventions, despite evidence that this drug class is associated with significant adverse events including death. Less than optimal staffing resources and lack of access to geropsychiatric specialists are barriers to reducing antipsychotic use. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Antipsychotic use occurred in 11.6% of nursing home residents without qualifying or potentially qualifying diagnoses (bipolar disorder and psychotic disorder); antipsychotic use was more prevalent in residents with a dementia diagnosis than those without. One additional registered nurse hour per resident day could reduce the odds of antipsychotic use by 52% and 56% for residents with and without a dementia diagnosis respectively. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given the influence of total staffing and professional staff mix on risk of antipsychotic use, nursing home administrators may want to consider aspects of facility operation that impact antipsychotic use. More stringent Unites States' survey and certification standards for dementia care implemented in 2017 demand proactive person-centered care that promotes maximal well-being and functioning without risk of harm from inappropriate psychoactive medications. Mental health nurses have requisite training to provide expert person-centered care to nursing home residents with mental illness and geropsychiatric disorders.

ABSTRACT

Introduction Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim This study identified risk factors of antipsychotic use in long-stay residents lacking qualifying or potentially qualifying diagnoses. Method This secondary analysis used 2015 Minimum Data Set and cost report data from 458 Missouri nursing homes. The full sample (N = 29,679) was split into two subsamples: residents with (N = 15,114) and without (N = 14,565) a dementia diagnosis. Separate logistic regression models were run. Results Almost 15% of the dementia subsample and 8.4% of the nondementia subsample received an antipsychotic medication in the past week. Post-traumatic stress disorder, psychosis indicators, behavioral symptoms, anxiety medication with and without anxiety diagnosis, depression medication with and without depression diagnosis, and nurse staffing were among the strongest predictors of antipsychotic use in both subsamples. Simulation analyses showed decreased odds of receiving an antipsychotic in both subsamples when registered nurse hours matched the national average. Discussion Matching nurse staffing mix to the national average may improve antipsychotic use in nursing homes. Implications Knowledge of antipsychotic use risk factors use can inform care planning and staff education to minimize use of these medications in all but severe cases.

Using PROMIS Pain Interference Items to Improve Quality Measurement in Inpatient Rehabilitation Facilities

OBJECTIVE

To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference items for use in a quality measure and to compare the resulting quality score, along with internal reliability and validity, to a similar item set in the Minimum Data Set Version 3.0 (MDS).

DESIGN

Cross-sectional, observational study.

SETTING

One freestanding inpatient rehabilitation facility (IRF) and one large hospital-based IRF.

PARTICIPANTS

Patients with neurologic disorders. Of 1055 consecutive admissions, 26% were excluded based on clinician-determined cognitive impairment or emotional distress. Of the remainder, 50% consented and completed the survey near the end of their IRF stay (N = 391). Of these, more than half (57%) reported pain over the last day (n = 224).

MEASUREMENTS

Psychometric statistics and quality scores were computed from a 55-question survey, including the MDS and PROMIS pain interference items.

RESULTS

Estimates for internal reliability were higher for the PROMIS 2-item scale compared to the MDS: Cronbach α (0.86 vs 0.48) and interitem correlations (0.75 vs 0.31). The PROMIS-2 items were better able to detect differences in patients with mild and severe pain intensity (Cohen d = 1.57) relative to the corresponding MDS items (Cohen d = 0.81). Two quality scores based on the PROMIS-2 items, reflecting low and high levels of pain interference, showed 46% or 12% of patients meeting these thresholds. This compared to a 30% rate when patients were classified by the MDS as experiencing pain interference.

CONCLUSIONS

PROMIS pain interference items appear to be more internally consistent than similar MDS items. The graded PROMIS items permit the creation of multiple quality scores, showing predictable overlap with corresponding MDS quality scores. Because PROMIS items provide finer distinctions, they allow greater latitude in reporting quality scores. We recommend further study of pain interference scores across IRFs to improve their reliability and validity.

Implementation of an Evidence-Based Practice Nursing Handover Tool in Intensive Care Using the Knowledge-to-Action Framework

BACKGROUND

Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, standardized handover tools for nursing team leaders (TLs) in intensive care are limited.

AIMS

The study aim was to implement and evaluate an evidence-based electronic minimum data set for nursing TL shift-to-shift handover in the intensive care unit using the knowledge-to-action (KTA) framework.

METHODS

This study was conducted in a 21-bed medical-surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in TL handover were recruited. Three phases of the KTA framework (select, tailor, and implement interventions; monitor knowledge use; and evaluate outcomes) guided the implementation and evaluation process. A postimplementation practice audit and survey were carried out to determine nursing TL use and perceptions of the electronic minimum data set 3 months after implementation. Results are presented using descriptive statistics (median, IQR, frequency, and percentage).

RESULTS

Overall (86%, n = 49), TLs' use of the electronic minimum data set for handover and communication regarding patient plan increased. Key content items, however, were absent from handovers and additional documentation was required alongside the minimum data set to conduct handover. Of the TLs surveyed (n = 35), those receiving handover perceived the electronic minimum data set more positively than TLs giving handover (n = 35). Benefits to using the electronic minimum data set included the patient content (48%), suitability for short-stay patients (16%), decreased time updating (12%), and printing the tool (12%). Almost half of the participants, however, found the minimum data set contained irrelevant information, reported difficulties navigating and locating relevant information, and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface.

LINKING EVIDENCE TO ACTION

Prior to developing and implementing electronic handover tools, adequate infrastructure is required to support knowledge translation and ensure clinician and organizational needs are met.

Developing a Minimum Data Set (MDS) for Cardiac Electronic Implantable Devices Implantation

Background:

There is no established minimum data set (MDS) for cardiovascular implantable electronic devices (CIEDs), which have led to a lack of standardized assessment criteria in this field to ensure access to a reliable and coherent set of data.

Objective:

To establish the minimum data set of CIEDs implantation that enables consistency in data gathering, uniform data reporting and data exchange in clinical and research information systems.

Methods:

This descriptive and cross-sectional study was conducted in 2018. That comprised a literature review to provide an overview of cardiovascular documents, registries, guidelines and medical record forms to extract an initial draft of potential data elements then asked from experts to review the initial draft of variables to score the items according to the importance perceived by them based on a five-point Likert scale. The items scored as important or highly important by at least 75% of the experts were included in the final list of minimum data set.

Results:

Initial dataset were refined by experts and essential data elements was selected in eight data classes including administrative data, past medical history, sign and symptoms, physical examinations, laboratory results, procedure session, post procedure complications and discharge outcomes. For each category required variables and possible respondents where determined.

Conclusions:

The minimum dataset will facilitate standardized and effective data management of CIEDs implantation; and presents a platform for meaningful comparison across contexts.

Clinical Complexity and Use of Antipsychotics and Restraints in Long-Term Care Residents with Parkinson's Disease

BACKGROUND

Patients with Parkinson's disease (PD) and/or Parkinsonism are affected by a complex burden of comorbidity. Many ultimately require institutional care, where they may be subject to the application of physical restraints or the prescription of antipsychotic medications, making them more vulnerable to adverse outcomes.

OBJECTIVES

The objectives of this paper are to: 1) describe the clinical complexity of older institutionalized persons with PD; and 2) examine patterns and predictors of restraint use and prescription of antipsychotics in this population.

METHODS

Population-based cross-sectional cohort study. Residents with PD and/or Parkinsonism living in long-term care (LTC) facilities in 6 Canadian provinces and 1 Northern Territory and Complex Continuing Care (CCC) facilities in Manitoba and Ontario, Canada. The RAI MDS 2.0 instrument was used to assess all LTC residents and CCC residents. Clinical characteristics and the prevalence of major comorbidities were examined. Multivariate modeling was used to identify the characteristics of PD residents most associated with the prescription of antipsychotics and the use of restraints in LTC and CCC facilities.

RESULTS

Residents with PD in LTC and CCC exhibit a high prevalence of dementia, major psychiatric disorders, stroke, heart failure, chronic obstructive pulmonary disease and diabetes mellitus. More than 90% of LTC and CCC residents with PD had cognitive impairment; with more than half having moderate to severe impairment. Residents with PD were more likely to receive antipsychotics than those without PD. Antipsychotic use was associated with psychosis and aggressive behaviours, but also with unsteady gait and higher comorbidity and medication count. Similarly, although more common in CCC than LTC facilities, both psychosis and aggressive behaviours were associated with restraint use, as was greater cognitive and functional impairment, and urinary incontinence. Younger age, male gender, and lower physician access were all associated with greater antipsychotic and restraint use.

CONCLUSIONS

LTC and CCC residents with PD are very complex medically. Use of antipsychotics and restraints is common, and their use is often associated with factors other than psychosis or aggression.

Occupational Disease Registries-Characteristics and Experiences

INTRODUCTION

Due to growth of occupational diseases and also increase of public awareness about their consequences, attention to various aspects of diseases and improve occupational health and safety has found great importance. Therefore, there is the need for appropriate information management tools such as registries in order to recognitions of diseases patterns and then making decision about prevention, early detection and treatment of them. These registries have different characteristics in various countries according to their occupational health priorities.

AIM

Aim of this study is evaluate dimensions of occupational diseases registries including objectives, data sources, responsible institutions, minimum data set, classification systems and process of registration in different countries.

MATERIAL AND METHODS

In this study, the papers were searched using the MEDLINE (PubMed) Google scholar, Scopus, ProQuest and Google. The search was done based on keyword in English for all motor engines including "occupational disease", "work related disease", "surveillance", "reporting", "registration system" and "registry" combined with name of the countries including all subheadings. After categorizing search findings in tables, results were compared with each other.

RESULTS

Important aspects of the registries studied in ten countries including Finland, France, United Kingdom, Australia, Czech Republic, Malaysia, United States, Singapore, Russia and Turkey. The results show that surveyed countries have statistical, treatment and prevention objectives. Data sources in almost the rest of registries were physicians and employers. The minimum data sets in most of them consist of information about patient, disease, occupation and employer. Some of countries have special occupational related classification systems for themselves and some of them apply international classification systems such as ICD-10. Finally, the process of registration system was different in countries.

CONCLUSION

Because occupational diseases are often preventable, but not curable, it is necessary to all countries, to consider prevention and early detection of occupational diseases as the objectives of their registry systems. Also it is recommended that all countries reach an agreement about global characteristics of occupational disease registries. This enables country to compare their data at international levels.

Infection Trends in US Nursing Homes, 2006-2013

OBJECTIVES

The objectives of this study were to estimate trends in the prevalence of infections in nursing home (NH) residents using 2006-2013 Minimum Data Set (MDS) data, estimate the number of all infections in 2013, and evaluate differences in trends between MDS versions 2.0 and 3.0.

DESIGN

Retrospective study.

SETTING

NHs in the United States.

PARTICIPANTS

All NH residents with a quarterly or annual MDS assessment in 2006-2013 (n = 30,366,807 assessments).

MEASUREMENTS

MDS 2.0 and 3.0 quarterly and annual assessment data (2006-2013) from over 15,000 NHs were used to estimate the 7-day prevalence of multidrug-resistant organism (MDRO) infection, pneumonia, septicemia, viral hepatitis, and wound infection and 30-day prevalence of urinary tract infection (UTI). Admission assessments were excluded. Annual infection counts were estimated using 2013 data. Changes in the prevalence of reported infections over time and differences in trends between MDS 2.0 and 3.0 were examined using tests of linear trends.

RESULTS

In 2013, there were an estimated 1.13 to 2.68 million infections in NH residents. UTI and pneumonia were the most commonly reported infections in every quarter, ranging from 5.6% to 8.1% and 1.4% to 2.5%, respectively. Prevalence of all infections increased in 2006-2010 (P values < .01). In 2011-2013, prevalence of UTI, MDRO, and wound infections decreased and viral hepatitis increased (P values < .0001). Between MDS 2.0 and 3.0, the prevalence of UTI, MDRO, and wound infections decreased and the prevalence of viral hepatitis increased (P values < .0001).

CONCLUSION

Infections are a major and persistent problem in NHs. Although MDS data are useful for identifying trends in infection prevalence, revisions in definitions need to be accounted for when evaluating trends over time. Additional research is needed to identify factors that contribute to changes in infection prevalence.

A proposed minimum data set for international primary care optometry: a modified Delphi study

PURPOSE

To identify a minimum list of metrics of international relevance to public health, research and service development which can be extracted from practice management systems and electronic patient records in primary optometric practice.

METHODS

A two stage modified Delphi technique was used. Stage 1 categorised metrics that may be recorded as being part of a primary eye examination by their importance to research using the results from a previous survey of 40 vision science and public health academics. Delphi stage 2 then gauged the opinion of a panel of seven vision science academics and achieved consensus on contentious metrics and methods of grading/classification.

RESULTS

A consensus regarding inclusion and response categories was achieved for nearly all metrics. A recommendation was made of 53 metrics which would be appropriate in a minimum data set.

CONCLUSIONS

This minimum data set should be easily integrated into clinical practice yet allow vital data to be collected internationally from primary care optometry. It should not be mistaken for a clinical guideline and should not add workload to the optometrist. A pilot study incorporating an additional Delphi stage prior to implementation is advisable to refine some response categories.

The Development of a National Census of the Health Information Workforce: Expert Panel Recommendations

BACKGROUND

There is a need to develop a national census of the health information workforce to inform the planning and forecasting of the workforce and inform education and training needs. Yet, this raises a number of issues that need to be incorporated into the planning stage. This paper discusses the issues and recommendations for the development of a national health information workforce census and an Expert Panel's recommendations for how we should proceed.

METHODS

Nominated participants from Australia and New Zealand participated as Expert Panel members in focus groups to identify and discuss the issues. Recommendations were identified during the focus groups and documented for participant verification. These were then grouped into themes.

RESULTS AND DISCUSSION

The themes of the issues and considerations identified in the focus groups were: Aim of the census; Census advertisement; Census delivery; Participants; Longitudinal study; Types of data elements; Data development and standards; Data ownership, access and governance; Global census; Dissemination of results.

Hemodialysis Adequacy Monitoring Information System: Minimum Data Set and Capabilities Required

Introduction:

In dialysis centers both nephrologists and nurses are faced with the challenge of ensuring reliable and efficient care accordance with the clinical guideline. Hemodialysis adequacy monitoring information system therefore enable the automation of tasks, which ultimately allows doctors and nursing staff more time to dedicate to the individual treatment of patients. Development of the information systems in healthcare has made the use of the Minimum data set inevitable. The purpose of this study was determined MDS and capabilities required in hemodialysis adequacy monitoring information system.

Method and materials:

This is a cross-sectional survey conducted with participation of 320 nephrology specialists in 2015. Data were collected using an electronic questionnaire which was estimated as both reliable and valid. The data were analyzed by SPSS software descriptive statistics and analytical statistics.

Results:

Overall 42 data elements were determined as final set in 4 major categories (patient demographics, medical history, treatment plan and hemodialysis adequacy). The most capabilities required of hemodialysis information system were related to calculate of dialysis adequacy Index (4.80), advice optimal dose of dialysis for each patient (4.63), Easy access to information system without restrictions of time and place (4.61), providing alerts when dialysis adequacy index below the standard (4.55) and Interchange to other information systems in hospitals (4.46) respectively.

Conclusion:

In design and implementation of information systems focus on MDS and identification IS capabilities based on the users’ needs, due to the wide participation users and also the success of the information system. Therefore it is necessary that MDS evaluated carefully with regard to the intended uses of the data. Also information systems based on capabilities the ability to meet the needs of their users.

Minimum data set for cystic fibrosis registry: a case study in iran

BACKGROUND

over the last 25 years several national registries of CF have been set up. Such systems can be very useful in providing an integrated resource for improving patient care and conducting research on the disease. Minimum Data Set is a common set of data items that should be used to collect and report data in the registry. The principal aim of this research was to determine minimum data set for the CF registry in north-west of Iran.

METHODS

data items collected by several selected registries of cystic fibrosis were studied and an initial set of data was selected by the researchers. A group of experts including epidemiologists, pediatricians, and CF specialists were asked to review the proposed data elements and score them based on their importance by using a nine-point Likert scale. The items scored as important or highly important by more than 50 % of the experts, were included in final list of minimum data set. Availability of data was evaluated through reviewing medical records of 144 patients hospitalized in Children Hospital located in Tabriz.

RESULTS

overall six classes of data (46 items) were identified in the selected registry systems for cystic fibrosis: patient demographics, administrative data, survival status, diagnostic procedures, genetic and clinical manifestations, and therapeutics. Thirty two data elements from all six categories of data were approved by the experts as the minimum data set for cystic fibrosis registry system. Availability of data in administrative category and survival class was 100 percent. Collecting data on medications was feasible in 100% of the cases as well. In class of demographic data, accessibility of patient name, age, gender, place of birth, and date of birth was 100 percent. In group of diagnostic procedures, partial availability of data was found for sweat test and genetic test. No data was found on the antenatal screening, exercise tolerance test, and glucose tolerance test.

CONCLUSION

this work can be considered as a first step toward establishing CF registry system in Iran. Minimum data set can be also useful in designing electronic registry or electronic patient records for those suffering from CF toward integration of their fragmented records across continuum of the health care system in order to improve quality of shared patient care.

A comparative study on iMed(©) and European database for multiple sclerosis to propose a common language of multiple sclerosis data elements

CONTEXT

Establishing and developing minimum data set (MDS), controlled vocabularies, taxonomies and classification systems are requirements of health information system in every society.

AIMS

The aim of this study was to propose an integrated multiple sclerosis (MS) data set by comparing European database for multiple sclerosis (EDMUS Coordinating Center Lyon, France) and iMed(©) software's (iMed, Merck Serono SA - Geneva). EDMUS is being developed at the EDMUS coordinating centers in Lyon, France and iMed(©) is owned and distributed by Merck Serono in Geneva, Switzerland.

SETTINGS AND DESIGNS

Retrieval of data of MDS performed through scholars responsible in related agencies and clinics.

MATERIALS AND METHODS

This research was an applied. The study was comparative-exploratory. In this study, data elements in iMed(©) and EDMUS software's were compared. Data collecting tool was data raw form.

STATISTICAL ANALYSIS USED

Results analyzing was carried out in a descriptive-comparative method. MS data elements were proposed in three general categories: administrative; clinical; and socio-economic. In this study, a MS data set was suggested by studying data elements of EDMUS and iMed(©) softwares.

RESULTS

The MS data set includes administrative, clinical and socio-economic data elements that collect information of MS patients during the treatment course. iMed(©), EDMUS and other available databases are suitable patterns for determining and recognizing MS key data elements.

CONCLUSION

Developing MS data set in this study and studying other available MS information systems result in establishing standardized MS data set. By establishing this data set, it will be possible to present MS MDS internationally. MS MDS is the main base of establishing MS information systems at different levels.

A methodology for a minimum data set for rare diseases to support national centers of excellence for healthcare and research

BACKGROUND

Although rare disease patients make up approximately 6-8% of all patients in Europe, it is often difficult to find the necessary expertise for diagnosis and care and the patient numbers needed for rare disease research. The second French National Plan for Rare Diseases highlighted the necessity for better care coordination and epidemiology for rare diseases. A clinical data standard for normalization and exchange of rare disease patient data was proposed. The original methodology used to build the French national minimum data set (F-MDS-RD) common to the 131 expert rare disease centers is presented.

METHODS

To encourage consensus at a national level for homogeneous data collection at the point of care for rare disease patients, we first identified four national expert groups. We reviewed the scientific literature for rare disease common data elements (CDEs) in order to build the first version of the F-MDS-RD. The French rare disease expert centers validated the data elements (DEs). The resulting F-MDS-RD was reviewed and approved by the National Plan Strategic Committee. It was then represented in an HL7 electronic format to maximize interoperability with electronic health records.

RESULTS

The F-MDS-RD is composed of 58 DEs in six categories: patient, family history, encounter, condition, medication, and questionnaire. It is HL7 compatible and can use various ontologies for diagnosis or sign encoding. The F-MDS-RD was aligned with other CDE initiatives for rare diseases, thus facilitating potential interconnections between rare disease registries.

CONCLUSIONS

The French F-MDS-RD was defined through national consensus. It can foster better care coordination and facilitate determining rare disease patients' eligibility for research studies, trials, or cohorts. Since other countries will need to develop their own standards for rare disease data collection, they might benefit from the methods presented here.

Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care

BACKGROUND

The purpose of this study was to determine the relationship between hypothesized pain behaviors in the elderly and a measurement model of pain derived from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0 items.

METHODS

This work included a longitudinal cohort recruited from Medicare-certified longterm care facilities across the United States. MDS data were collected from 52,996 residents (mean age 83.7 years). Structural equation modeling was used to build a measurement model of pain to test correlations between indicators and the fit of the model by cognitive status. The model evaluates the theoretical constructs of pain to improve how pain is assessed and detected within cognitive levels.

RESULTS

Using pain frequency and intensity as the only indicators of pain, the overall prevalence of pain was 31.2%; however, analysis by cognitive status showed that 47.7% of the intact group was in pain, while only 18.2% of the severely, 29.4% of the moderately, and 39.6% of the mildly cognitively impaired groups were experiencing pain. This finding supports previous research indicating that pain is potentially under-reported in severely cognitively impaired elderly nursing home residents. With adjustments to the measurement model, a revised format containing affective, behavioral, and inferred pain indicates a better fit of the data to include these domains, as a more complete measure of the pain construct.

CONCLUSION

Pain has a significant effect on quality of life and long-term health outcomes in nursing home residents. Patients most at risk are those with mild to severe cognitive decline, or those unable to report pain verbally. Nursing homes are under great scrutiny to maintain standards of care and provide uniform high-quality care outcomes. Existing data from federally required resident surveys can serve as a valuable tool to identify indicators of pain and trends in care. Great responsibility lies in ensuring pain is included and monitored as a quality measure in long-term care, especially for residents unable to communicate their pain verbally.

The quality of the quality indicator of pain derived from the minimum data set

OBJECTIVE

To examine facility variation in data quality of the level of pain documented in the minimum data set (MDS) as a function of level of hospice enrollment in nursing homes (NHs).

DATA SOURCE

Clinical assessments on 3,469 nonhospice residents from 178 NHs were merged with On-line Survey Certification and Reporting data of 2000, Medicare Claims data of 2000 and the MDS of 2000-2002.

STUDY DESIGN

Using the same assessment protocol, NH staff and study nurses independently assessed 3,469 nonhospice residents. Study nurses' assessments being gold standard, we quantified and compared quality of NH staff's pain rating across NHs with high, medium, or low hospice use. Multilevel models were built to assess the effect of NH hospice use levels on the occurrence of false positive (FP) and false negative (FN) errors in NH-rated "severe pain."

PRINCIPAL FINDINGS

Of 178 NHs, 25 had medium and 41 high hospice use. NHs with higher hospice use had lower sensitivities. In multilevel analysis, we found a significant facility-level variation in the probability of FP and FN errors in facility-rated "severe pain." Resident characteristics only explained 4 and 0 percent of the facility variation in FP and FN, respectively; characteristics and locations (state) of NHs further explained 53 and 52 percent of the variance. After controlling for resident and NH characteristics, staff in NHs with medium or high hospice use were less likely to have FP or FN errors in their MDS documentation of pain than were staff in NHs with low or no hospice use.

CONCLUSIONS

The examination of data quality of pooled MDS data from multiple NHs is insufficient. Multilevel analysis is needed to elucidate sources of heterogeneity in the quality of MDS data across NHs. Facility characteristics, e.g., hospice use or NH location, are systematically associated with overrated/underrated pain and may bias pain quality indicator (QI) comparisons. To ensure the integrity of QI comparison in the NH setting, the government may need to institute regular audits of MDS data quality.